Provider Demographics
NPI:1699117994
Name:O'CONNOR, KIMBERLY (LMFT)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 GRAND PL
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06470-2114
Mailing Address - Country:US
Mailing Address - Phone:203-597-7927
Mailing Address - Fax:
Practice Address - Street 1:202 PLAYHOUSE COR
Practice Address - Street 2:
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-2265
Practice Address - Country:US
Practice Address - Phone:203-518-5380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-27
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1615106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTMEDICAID ID-00804972Medicaid